A Meta-analysis Of The Treatment Of Perimenopausal Syndrome By Nourishing The Kidney And Benefiting The Yin

Objective: Nourishing kidney and tonifying yin is a common treatment for PMS,but there is no evidence of evidence-based medicine to prove its effectiveness.Through understanding the status quo of clinical research on the treatment of perimenopausal syndrome with the method of nourishing the kidney and tonifying yin recently,this study systematically evaluated and summarized the curative effect of the method of nourishing the kidney and tonifying yin on patients with PMS by using the method of meta-analysis,and compared the advantages of HRT of western medicine alone,to provide better plans for the treatment of PMS,as well as scientific clinical medication basis and evidence-based guidance.Methods: By searching CNKI,Wanfang Medical Database,VIP,CBM,Pubmed and other literature databases,the relevant literatures of randomized controlled trials of patients with PMS treated with the way of nourishing the kidney and tonifying yin were collected.The time was from the establishment of the database to October 31,2022.In strict accordance with the inclusion and exclusion criteria,select the articles that meet the research content,select the Cochrane risk deviation assessment tool to evaluate the quality of the study,and then extract the required data and use Rev Man5.4 and Stata MP15 software to analyze the collected data.Result: Through screening,a total of 26 eligible documents were included in this study,all of which were randomized controlled studies.There were 1053 cases in the experimental group and 1028 cases in the control group,with a total of 2081 cases.Among them,27 cases of shedding due to various reasons were not included.The outcome indicators were: total clinical response rate,Kupperman score,symptom score,HAMD score,FSH,LH,AMH,TC,TG,and incidence of adverse reactions.After meta-analysis,the data showed that 25 studies involved the total effective rate of clinical efficacy,with RR95%CI=1.15 [1.10,1.20],P<0.0001.This indicates that the method of nourishing the kidney and tonifying yin is more effective than HRT in treating PMS,and the overall efficacy is better.Among them,the combination of traditional Chinese and Western medicine and the simple method of nourishing the kidney and tonifying yin in traditional Chinese medicine have similar differences in overall efficacy compared to HRT.The combination of traditional Chinese and Western medicine has a better trend,and traditional Chinese medicine decoction different dosage forms of granules and traditional Chinese patent medicines and simple preparations have a greater impact on the comprehensive efficacy,and decoction and traditional Chinese patent medicines and simple preparations have a better effect than granules;12 studies tracked the improvement of Kupperman scores in patients,with SMD95% CI=-1.06 [-1.68,-0.44],P=0.0008<0.05,indicating that the nourishing kidney and tonifying yin method is more advantageous than HRT in reducing Kupperman scores in patients;4 studies tracked the changes in symptom scores of patients,and the results showed that the method of nourishing the kidney and tonifying yin was more effective in improving symptoms such as irritability and insomnia compared to HRT.There was no significant advantage in improving dryness,sweating,and lower back and knee pain;12 studies have elucidated the occurrence of adverse reactions,with RR95% CI=0.42[0.28,0.63] and P<0.001,indicating that the method of nourishing the kidney and tonifying yin has a lower incidence of adverse reactions and higher safety compared to HRT;2 studies described the HAMD scores of patients before and after treatment,with MD95% CI=-2.96 [-5.12,-0.79],P=0.007<0.05,indicating that the nourishing kidney and tonifying yin method is more effective in improving patients’ depression and anxiety compared to HRT;22 studies recorded changes in FSH levels,with SMD95% CI=-0.93 [-1.53,-0.34],P=0.002<0.05.Subgroup analysis showed that the combination of traditional Chinese and Western medicine had a significant advantage in improving FSH levels compared to HRT.However,the simple treatment of nourishing the kidney and tonifying yin with traditional Chinese medicine had no significant difference in reducing FSH efficacy compared to HRT.17 studies recorded changes in LH levels,with SMD95% CI=-1.12 [-1.85,-0.39],P=0.003<0.05,Subgroup analysis showed that the combination of traditional Chinese and Western medicine had a significant advantage in improving LH levels compared to HRT,while the traditional Chinese medicine nourishing kidney and tonifying yin method alone had no significant difference in reducing LH efficacy compared to HRT;2studies tracked the changes in AMH levels,with SMD95% CI=0.41 [0.02-0.79] and P=0.04<0.05,indicating that the method of nourishing the kidney and tonifying yin is more advantageous than HRT in improving ovarian reserve function in patients;2 articles have tracked the levels of TC and TG,and the analysis results suggest that the method of nourishing the kidney and tonifying yin is more advantageous in reducing TC and TG levels compared to HRT in the treatment of PMS.Conclusions:1.When treating PMS,nourishing the kidney and tonifying yin method or combined with HRT can significantly improve the clinical comprehensive efficacy of PMS,which is beneficial for reducing Kupperman score,improving symptoms of irritability,insomnia,improving ovarian reserve function,improving patient anxiety,improving blood lipid levels,and the efficacy is superior to HRT.The method of nourishing the kidney and tonifying yin has a lower incidence of adverse reactions and higher safety.There is no significant difference in the therapeutic effect of nourishing the kidney and tonifying yin method compared to HRT in improving symptoms of hot sweating,waist and knee pain and discomfort.2.Compared with HRT treatment,the traditional Chinese medicine method of nourishing the kidney and tonifying yin has no significant advantage in reducing FSH and LH levels,while the combination of traditional Chinese and Western medicine has a more significant advantage over HRT treatment.3.There are still some shortcomings in this research method.The randomized controlled studies included are all small sample studies,and most of the papers on traditional Chinese medicine are Chinese literature,lacking high-quality English literature,resulting in low stability and absolute persuasiveness of the research results.Therefore,the conclusion still needs to be confirmed through a large number of effective clinical randomized studies.